Systematic review and meta-analysis of radiotherapy in various head and neck cancers: Comparing photons, carbon-ions and protons

Ramaekers, Bram L.T.; Pijls-Johannesma, Madelon; Joore, Manuela A.; van den Ende, Piet; Langendijk, Johannes A.; Lambin, Philippe; Kessels, Alfons G.H.; Grutters, Janneke P.C.

doi:10.1016/j.ctrv.2010.08.004

« Previous Next »Cancer Treatment Reviews
Volume 37, Issue 3 , Pages 185-201, May 2011

Systematic review and meta-analysis of radiotherapy in various head and neck cancers: Comparing photons, carbon-ions and protons

Bram L.T. Ramaekers
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 1588, 6201 BN Maastricht, The Netherlands
- Corresponding author. Tel.: +31 (0) 88 44 55 798; fax: +31 (0) 88 44 55 667.
Madelon Pijls-Johannesma
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 1588, 6201 BN Maastricht, The Netherlands
- Tel.: +31 (0) 88 44 55 666; fax: +31 (0) 88 44 55 667.
Manuela A. Joore
- Department of Health Organization, Policy and Economics (HOPE), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
- Tel.: +31 (0) 43 388 2907; fax: +31 (0) 43 367 0960.
- Tel.: +31 (0) 43 387 5559; fax: +31 (0) 43 387 4419.
Piet van den Ende
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 1588, 6201 BN Maastricht, The Netherlands
- Tel.: +31 (0) 88 44 55 666; fax: +31 (0) 88 44 55 667.
Johannes A. Langendijk
- Department of Radiation Oncology, University Medical Center Groningen/University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
- Tel.: +31 (0) 50 361 5532; fax: +31 (0) 50 361 3672.
Philippe Lambin
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 1588, 6201 BN Maastricht, The Netherlands
- Tel.: +31 (0) 88 44 55 666; fax: +31 (0) 88 44 55 667.
Alfons G.H. Kessels
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
- Tel.: +31 (0) 43 387 5559; fax: +31 (0) 43 387 4419.
- These authors contributed equally to this work.
Janneke P.C. Grutters
- Department of Health Organization, Policy and Economics (HOPE), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Tel.: +31 (0) 43 388 2907; fax: +31 (0) 43 367 0960.
- These authors contributed equally to this work.

Received 21 June 2010; received in revised form 4 August 2010; accepted 8 August 2010. published online 03 September 2010.

Abstract

Purpose

To synthesize and compare available evidence considering the effectiveness of carbon-ion, proton and photon radiotherapy for head and neck cancer.

Methods

A systematic review and meta-analyses were performed to retrieve evidence on tumor control, survival and late treatment toxicity for carbon-ion, proton and the best available photon radiotherapy.

Results

In total 86 observational studies (74 photon, 5 carbon-ion and 7 proton) and eight comparative in-silico studies were included. For mucosal malignant melanomas, 5-year survival was significantly higher after carbon-ion therapy compared to conventional photon therapy (44% versus 25%; P-value 0.007). Also, 5-year local control after proton therapy was significantly higher for paranasal and sinonasal cancer compared to intensity modulated photon therapy (88% versus 66%; P-value 0.035). No other statistically significant differences were observed. Although poorly reported, toxicity tended to be less frequent in carbon-ion and proton studies compared to photons.

In-silico studies showed a lower dose to the organs at risk, independently of the tumor site.

Conclusions

For carbon-ion therapy, the increased survival in mucosal malignant melanomas might suggest an advantage in treating relatively radio-resistant tumors. Except for paranasal and sinonasal cancer, survival and tumor control for proton therapy were generally similar to the best available photon radiotherapy. In agreement with included in-silico studies, limited available clinical data indicates that toxicity tends to be lower for proton compared to photon radiotherapy.

Since the overall quantity and quality of data regarding carbon-ion and proton therapy is poor, we recommend the construction of an international particle therapy register to facilitate definitive comparisons.

Keywords: Radiotherapy, Photon, IMRT, Particle, Carbon-ion, Proton, Head and neck cancer, Meta-analysis, Systematic review